Biomedical subjects
N Waterhouse
Publications and source records attributed to N Waterhouse.
Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis.
We present our experience using the vastus lateralis myocutaneous flap for the repair of defects around the groin and pelvis. It is a relatively new technique, with many advantages over other flaps used in this area, though it has limitations. The history, anatomy and surgical technique of raising the flap are described and clinical cases are discussed. The importance of patient selection is highlighted.
The versatility of the lateral arm flap.
We present our experience of a personal series of 17 lateral arm flaps in a variety of forms and clinical situations. The anatomy of the flap is briefly reviewed in relation to the operative findings, and the advantages and disadvantages of the flap are discussed.
The innervated trapezius flap in facial paralysis.
The use of an innervated lateral trapezius flap to allow movement of the paralysed face is described. Five cases are presented, all of whom achieved some facial movement postoperatively. The place of this technique in the armamentarium of procedures for facial reanimation is discussed.
The blood supply of the osteocutaneous free fibular graft.
The use of an osteocutaneous free fibular graft as a single-stage reconstructive procedure for composite tissue loss is increasingly common. Detailed anatomical study in cadavers of the blood supply to the graft demonstrates cutaneous arteries arising from the peroneal artery and then passing along the posterior surface of the lateral intermuscular septum. These vessels pierce the crural fascia and then ramify to supply the skin. Knowledge of the vascular anatomy of the skin overlying the fibula is essential to the success of the graft.
[Complex reconstruction using amputation tissues].
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The lateral arm flap: an anatomic study.
The anatomy of the lateral arm flap is further elucidated, and the surgical techniques involved in raising the flap are described in detail. The data are derived from studies in 25 cadavers and five clinical cases. The relative merits of this versatile free flap are discussed. Three clinical cases are cited for illustration.
Reconstruction of the pelvis using a composite island flap salvaged from the remaining leg.
The case of a patient who sustained horrific injuries resulting in the loss of his left leg and hemipelvis and damage to the right sacroiliac joint and leg is discussed. The remaining leg was paralyzed as a result of damage to the sacral plexus. As a salvage procedure, a right above-knee amputation was performed, preserving a large composite flap from the distal part of the limb. This flap, consisting of most of the skin and soft tissue of the lower leg, contained within it a 10 cm segment of tibia and fibula. By islanding the flap on a pedicle composed of the femoral vessels, saphenous, and sciatic nerves, it was possible to mobilize it sufficiently far proximally to reconstruct the bone and soft-tissue defect of the contralateral hemipelvis. Seven years after this appalling injury, the patient has achieved a remarkable psychological and functional rehabilitation. He is independent and is successfully pursuing a professional career. This case report is a dramatic illustration of what can be achieved in reconstruction following trauma using salvage techniques.
Urinary retention after total hip replacement. A prospective study.
We report a prospective study of the factors associated with acute urinary retention after total hip replacement in 103 consecutive male patients. Eleven patients (10.7%) developed retention after operation. Of the factors investigated before operation three had predictive value: inability to pass urine into a bottle whilst lying in bed, urinary peak-flow rates indicative of obstruction, and a history of previous bladder outflow problems. This study suggests that patients showing one or more of these factors should be assessed and if necessary treated by a urologist before arthroplasty, so as to avoid the need for catheterisation, and the consequent risk of deep infection.
The clavicular head of pectoralis major musculocutaneous free flap.
A new free flap is described based on the deltoid vessels of the acromiothoracic axis. The flap is comprised of the clavicular head of pectoralis major muscle with overlying skin. It is also possible to harvest vascularised clavicular bone with the flap. The vascular anatomy is reviewed and the technique of raising the flap described. Its clinical application is illustrated with five cases. Four of these were intra-oral reconstructions and the fifth a composite osteo-musculocutaneous flap to a lower limb following trauma.
Observations on dermal blood flow as reflected by technetium-99m pertechnetate clearance.
Skin blood flow as reflected by the clearance rate of intradermal injections of Technetium-99m (99mTc) was studied in the skin of human volunteers and in a variety of clinical situations. In volunteers comparisons between the effect on clearance following intradermal injections of either lignocaine or lignocaine/adrenaline showed that the latter resulted in a dramatic reduction in the clearance rate of the technetium isotope and that such clearance curves exhibited no fast component. Clinical studies in grossly ischaemic skin revealed a similar absence of the fast component of isotope clearance and this was also the case for healed split thickness skin grafts. The dermal isotope clearance was also used in pedicle skin flaps both before and after clamping the axial pedicle in order to derive clearance ratios which would reflect the degree of neovascularisation to the flap. These preliminary observations suggest that the technique is safe, and easy to use in many clinical circumstances. We consider that it offers a valuable method by which changes in dermal blood flow may be quantified, when simultaneous control areas of isotope clearance are also studied. Suggestions are made for further avenues of study.
A review of five years experience of digital replantation.
A five year experience of digital replantation is reviewed. The crude survival rate of 50% is lower than that reported in other comparable series and emphasis is placed on the reasons for failure and implication that they may have on future policy.
The development of a dynamic model for microvascular research and practice using human placenta: a preliminary report.
Human placenta has been investigated in an attempt to develop a non-animal model for microvascular research and practice, with a dynamic artificial circulation. Initial work has been encouraging and further development is in progress.
Lengthening of a short traumatic femoral stump.
A case is reported in which a severe open injury of the thigh eventually required amputation of the lower limb. Lengthening of the short proximal femoral stump was achieved by turning over a flap comprising bone and soft tissue, with sensation, from the ipsilateral leg.
One stage thumb reconstruction using a previously injured little finger from the contralateral hand.
A patient, with a combination of unrelated hand injuries, underwent a one stage thumb reconstruction, utilizing the stump of the opposite little finger by means of a free tissue transfer.
Birmingham Medical Research Expeditionary Society 1977 Expedition: Psychological aspects of acute mountain sickness.
In order to assess the importance of personality and expectations in the development of Acute Mountain Sickness (AMS), 3 standard personality questionnaires and a Mountain Sickness Anticipation Questionnaire were completed by all of the 17 BMRES expedition members before their departure for the Himalayas. AMS could not be predicted with these tests and its occurrence, when assessed either by clinical interview or by peer review, bore no significant relationship to personality. For comparison daily self-assessment of the signs and symptoms of AMS were also conducted throughout the expedition, using graduated and graphic rating scales. The results were found to be unreliable and dependent upon personality factors. These findings have implications for those assessing others at high altitude.
Student views on continuous assessment at Birmingham University Medical School.
Student opinion on the system of continuous assessment used at Birmingham Medical School was sampled by distributing questionnaires to 621 students in the first four years of the course; 482 questionnaires (78%) were returned. Many comments and criticisms of the system were received but the vast majority of students (92%) said they preferred the present style of assessment to conventional final examinations. These criticisms are discussed and recommendations are made to improve the existing scheme.
A new technique for harvesting calvarial bone.
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